Healthcare Provider Details

I. General information

NPI: 1669493078
Provider Name (Legal Business Name): JULIA ANN BOYD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 CLYO RD STE B
CENTERVILLE OH
45459-2786
US

IV. Provider business mailing address

6611 CLYO RD STE B
CENTERVILLE OH
45459-2786
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-7474
  • Fax: 937-208-7470
Mailing address:
  • Phone: 937-208-7474
  • Fax: 937-208-7470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35057343
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: